Inserter

ABSTRACT

The present invention relates to an inserter for an intrauterine system, comprising a handle ( 3 ) having a longitudinal opening ( 8 ) at its first end, said opening ( 8 ) having a longitudinal axis parallel to the longitudinal axis of the inserter, a first end ( 8   a ) and a second end ( 8   b ), a movable slider ( 5 ) arranged in said longitudinal opening ( 8 ) and having a first end ( 5   a ) and a second end ( 5   b ), a plunger ( 2 ) attached to the handle ( 3 ) and having a longitudinal axis, and an insertion tube ( 6 ) having a first end, a second end and a longitudinal axis essentially parallel to the longitudinal axis of the plunger ( 2 ), the insertion tube ( 6 ) being, along said longitudinal axis, movably arranged around the plunger ( 2 ). The invention is characterised in that it further comprises a flange ( 4 ) arranged on the insertion tube ( 6 ) at its first end, and means for locking the slider ( 5 ) into a position showing the correct insertion depth for the intrauterine system, said means being adjustable with respect to the opening ( 8 ) of the handle.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/647,104, filed Jul. 11, 2017, which is a divisional of U.S. patentapplication Ser. No. 14/590,969, filed Jan. 6, 2015 (now U.S. Pat. No.9,707,123), which is a continuation of U.S. patent application Ser. No.13/857,134, filed Apr. 4, 2013 (now abandoned), which is a continuationof U.S. patent application Ser. No. 13/119,399, filed Mar. 16, 2011 (nowabandoned), which is a U.S. national phase application of InternationalPatent Application No. PCT/FI2009/050733, filed Sep. 11, 2009, whichclaims priority to Finnish Patent Application No. 20080524, filed Sep.17, 2008, the contents of all of which are incorporated herein byreference in their entirety.

The present invention is related to an inserter for positioning anintrauterine device or an intrauterine system in the uterus.

BACKGROUND OF THE INVENTION

Various types of inserters have been developed for the positioning ofmechanical and copper wire-containing intrauterine devices (IUDs) aswell as of intrauterine systems having a drug containing cylinder(IUSs). In the following, IUD and IUS can be used interchangeably andwhen one is mentioned, it is to be understood that either of them can beused.

Most common inserters are constructed for introducing the device intothe uterus in a contracted state. These inserters usually comprise aninsertion tube having a relatively narrow diameter and a rounded, bluntend which will pass through the cervical canal easily and will notdamage or injure the fundus upon contact therewith, and a plunger insidethe insertion tube. Prior to insertion the device, whether an IUD or anIUS, is usually retracted into the insertion tube either by means ofstring(s) attached to the device and intended for the removal of thedevice from the uterus, or by pushing the device into the insertion tubeby a plunger with inserters having a special window to adapt the devicein the expanded shape (see for example GB 1 403 393). Then the insertiontube with the device therein is introduced through the cervical canalinto the uterus. When the device is correctly positioned, it is releasedeither by pushing the plunger towards the uterus or by holding theplunger steady and by retracting the insertion tube outwards. Onceexpulsed from the insertion tube within the uterine cavity, the deviceis supposed to resume its original expanded shape.

Simple rod-shaped inserters have been suggested for inserting relativelysmall or sufficiently flexible intrauterine devices in their original,expanded shape by using simple push-in technique. With these insertersthe correct positioning and a secure attachment of an IUS or IUD on theinserter as well as a proper handling of the removal strings may bedifficult. Therefore there is still need for an improved inserter.

European patent application EP1 691 740 relates to an inserter, withwhich the correct positioning and directional stiffness of the device inthe inserter prior to and during insertion can be ensured, for instance,by shaping the forward end of the plunger such that the IUS assumes aspecified constant configuration when drawn into the insertion tube. TheIUS thus will not be twisted during insertion.

European patent EP 798 999 relates to an inserter, which allows thecorrect positioning of an IUS also in those cases in which the elongatemember of a T-shaped device contains active material, which involves adiameter larger than that of an elongate member of a copper-wire IUD.The inserter comprises a plunger, a handle attached to the plunger, astring for the removal of the IUS, a cleft on the end of the handle tolock the string(s) in such a way that the IUS remains immobile inrelation to the plunger, and an insertion tube around the plunger. TheIUS is drawn into the insertion tube by pushing the tube over the deviceor by pulling on the removal threads where after the threads aremanually locked in the cleft. The relative movement of the plunger andthe protective tube is restricted by a stop member or stop members toascertain that the correct configuration of the IUS is achieved. Thestop members ensure that the front edge of the insertion tube is stoppedin a configuration in which the hemispherical tips of the T-wings remainpartly uncovered by the insertion tube but the wings nevertheless remainpressed against each other. These stop members are however fixed on thehandle.

The inserters described in these documents overcome many of the problemsencountered with the conventional inserters, but the string(s) stillneed to be handled and manually locked. Further, the inserters aredesigned primarily for the insertion of the conventional devices whichare to be inserted in a compressed configuration. Therefore there isstill need for an improved inserter, which can be used to insert inoriginal expanded configuration intrauterine devices and systems havingframes of various shapes.

OBJECT AND SUMMARY OF THE INVENTION

An object of the invention is to provide a simple, easy to use inserterfor the positioning of an intrauterine system in the uterus by solvingat least partially at least some of the problems mentioned above. Anobject of the invention is particularly to provide an inserter having animproved system for securing the simple and correct positioning of theintrauterine system in the uterus.

A typical inserter for an intrauterine system according to the presentinvention, comprises

-   -   a handle having a longitudinal opening at its first end, said        opening having a longitudinal axis parallel to the longitudinal        axis of the inserter, a first end and a second end,    -   a movable slider arranged in said longitudinal opening and        having a first end and a second end,    -   a plunger attached to the handle and having a longitudinal axis,    -   an insertion tube having a first end, a second end and a        longitudinal axis essentially parallel to the longitudinal axis        of the plunger, the insertion tube being, along said        longitudinal axis, movably arranged around the plunger,    -   a flange arranged on the insertion tube at its first end.

The inserter is characterized in that it further comprises

-   -   means for locking the slider into a position showing the correct        insertion depth for the intrauterine system, said means being        adjustable with respect to the opening of the handle.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 illustrates a general overview of an inserter according to anembodiment of the invention.

FIGS. 2A, 2B, 2C and 2D illustrate an operating principle of an inserteraccording to an embodiment of the invention.

FIGS. 3A and 3B illustrate a locking means according to an embodiment ofthe invention.

FIGS. 4A and 4B illustrate a locking means according to anotherembodiment of the invention.

FIGS. 5A and 5B illustrate a locking means according to yet anotherembodiment of the invention.

FIGS. 6A and 6B illustrate a locking means according to a furtherembodiment of the invention.

FIGS. 7A and 7B illustrate a locking means according to still a furtherembodiment of the invention.

FIGS. 8A and 8B illustrate an intrauterine system and its positioning onthe inserter according to an embodiment of the invention.

FIGS. 8C and 8D illustrate another intrauterine system and itspositioning on the inserter according to an embodiment of the invention,

FIGS. 9A and 9B illustrate some details of FIG. 8B.

DETAILED DESCRIPTION OF THE INVENTION

A typical inserter for an intrauterine system according to the presentinvention, comprises

-   -   a handle having a longitudinal opening at its first end, said        opening having a longitudinal axis parallel to the longitudinal        axis of the inserter, a first end and a second end,    -   a movable slider arranged in said longitudinal opening and        having a first end and a second end,    -   a plunger attached to the handle and having a longitudinal axis,    -   an insertion tube having a first end, a second end and a        longitudinal axis essentially parallel to the longitudinal axis        of the plunger, the insertion tube being, along said        longitudinal axis, movably arranged around the plunger,    -   a flange arranged on the insertion tube at its first end.

The inserter is characterized in that it further comprises

-   -   means for locking the slider into a position showing the correct        insertion depth for the intrauterine system, said means being        adjustable with respect to the opening of the handle.

The invention therefore provides an easy to use inserter, by which onlyfew simple steps are needed to prepare for the insertion and to securelyinstall and position an intrauterine system into the uterus.

The longitudinal opening on the handle can have be also quite narrow anddoes not need to be symmetrically positioned on the handle and withrespect to the longitudinal axis.

The inserter comprises a flange arranged on the insertion tube at itsfirst end. The aim of this flange is to keep the intrauterine system ina correct position and to protect it prior to insertion. The flange alsofunctions as part of the means regulating the movement of the insertiontube.

The inserter may further comprise means for holding and guiding thestrings during the insertion so that no manual handling of said stringswill be needed. The inserter may also comprise locking means forreversibly locking the strings to immobilize the intrauterine system inrelation to the plunger, said locking means being controllable by theslider and/or by the insertion tube.

The inserter according to the invention is suitable for the positioningof intrauterine devices and intrauterine systems having different sizesand shapes. The inserter is especially suitable for installingintrauterine devices having a flexible frame with continuous curvedshape, for example annular, circular, oval, spiral, toroidal,triangular, shield-like, almond-like, diamond-like, elliptical orpolygonal shape.

In the present description and claims, by first ends are typically meantthe ends that are closer to the uterus during the insertion of theintrauterine system. Second ends are the ends opposite to the firstends. Moreover, the terms IUS or IUD and removal strings are used whendescribing the preferred embodiment of the present invention, but theseare not to be construed as limiting the claims.

A part of the handle comprises an opening having a first end and asecond end and running in the longitudinal direction of the plunger. Thehandle also preferably has at its first end a channel in which theinsertion tube can slide in the longitudinal direction.

The handle can have many shapes and is designed for easy handling of theinserter even by using only one hand. The plunger attached to the handleis advantageously hollow or has a groove or bore running in the axialdirection thus allowing the string(s) to slide freely in it, without anyrisk of them getting jammed between the plunger and the insertion tube.To enable the optimal and secure positioning of the intrauterine systemin the inserter the forward end of said plunger is shaped to the form ofa a slot or an extension to adapt the reservoir of the intrauterinesystem. Thus the IUS will not drop or be twisted during insertionprocedure and assumes a specified constant configuration when released.

The forward part (part directed towards the uterus) of the inserter ispreferably made of a flexible material to avoid perforation of theuterus, and can be straight or curved so as to conform to the anatomy ofthe uterus. The first end of the insertion tube comprises a flange andboth are made of a relatively flexible material, but are preferablystiffer than the plunger.

The slider mechanism is preferably inside the handle and comprises atleast one elongated element, which can be moved in the longitudinaldirection of the insertion tube. According to an embodiment of theinvention the slider comprises a means to move the slider, whichpreferably is a part of the slider. According to another embodiment ofthe invention the slider comprises at least two elements, preferablyparallel, which are combined on at least one point by a transversalmember. The transversal member may form means, for example a knob orswitch, by which the slider can be moved. The handle can comprise one ormore means to adapt the slider elements and to facilitate the movementof the slider, for example a support, a shoulder, a holder, a saddle, agroove or a slot. The slider may also comprise at least one structuralelement, for example an extension, which is capable to generate thenecessary operation of the possible locking means to keep the stringsimmobilized during storage or during preparatory steps before insertionand/or to release the string(s) when the slider is moved to the backwardposition.

To ensure the correct positioning of the intrauterine system in theuterus, the slider is adjusted to correspond to the depth at whichintrauterine system will be inserted, said depth being beforehanddetermined by using a sound or a probe. The slider comprising said meansfor locking it, which means are adjustable with respect to the openingof the handle can be for example a self-locking button slider andmovable in a stepwise way controlled for example by an indentation, acogwheel or a rack and pinion mechanism positioned inside the handle.The outer side of the handle has clear depth markings to facilitate theadjustment of the slider.

The slider and/or the insertion tube may additionally comprise at leastone structural element, for example an extension, which is capable togenerate the necessary operation of the locking means to keep thestrings immobilized during storage or during preparatory steps beforeinsertion or to release the string(s) when the slider is moved to thebackward position.

According to an embodiment of the invention relating to the kitcomprising also an intrauterine system, a therapeutic component of theintrauterine system is connected to the frame in at least one point.Moreover, the intrauterine system can be connected to the inserter forexample via at least one connection part. The connection part ispreferably designed such that it enhances the retention of the device onthe inserter prior and during the insertion of the device.

The connection part can be for example a hollow knob, adapted to receivea pin, one of these parts being arranged on the intrauterine system andthe other on the inserter. Another option is to use a traditional balljoint. A person skilled in the art is readily able to find a suitablesolution for this connection part.

Also in view of this, and according to an embodiment of the invention,the first end of the plunger comprises at least one connection slot forreceiving the connection part of the intrauterine system. The first endof the plunger may also comprise two diagonally symmetrical connectionslots for receiving the connection part of the intrauterine system. Itis naturally possible that there are more than two connection slots,such as three, four, five or six slots. The connection part thenpreferably comprises suitable parts fitting to these connections slots.

According to another embodiment of the invention, the first end of theplunger comprises at least one frame slot for receiving the frame of theintrauterine system. The first end of the plunger may also comprise twodiagonally symmetrical frame slots for receiving the frame of theintrauterine system. The number of frame slots can also be higher, suchas three, four, five or six. The frame slots can be parallel to thelongitudinal axis of the plunger or non-parallel to it. The frame slotscan for example be straight or slightly curved with respect to the outersurface of the plunger, in order for allowing the frame to be released.The frame slots are preferably narrow enough to prevent the therapeuticcomponent from slipping out and long enough to allow the movement of thetherapeutic component and the stretching/compression of the frame duringthe insertion step. The plunger or at least the first end of the plungeris large enough for containing the therapeutic component. The frameslot(s) together with connection parts and the flange assure that theintrauterine system will be securely fitted and in the correctconfiguration during the insertion.

According to a further embodiment of the invention, the first end of theinsertion tube comprises at least one frame slot for receiving the frameof the intrauterine system. The first end of the insertion tube may alsocomprise two diagonally symmetrical frame slots for receiving the frameof the intrauterine system. The number of frame slots can also behigher, such as three, four, five or six. The frame slots can beparallel to the longitudinal axis of the insertion tube or non-parallelto it. The frame slots can for example be straight or slightly curvedwith respect to the outer surface of the insertion tube, in order forallowing the frame to be released. The frame slots are preferably narrowenough to prevent the therapeutic component from slipping out and longenough to allow the movement of the therapeutic component and thestretching/compression of the frame.

The inserter according to the present invention may also compriselocking means for reversibly locking the intrauterine system in relationto the plunger, said locking means being controllable by the sliderand/or the insertion tube. This means that the locking means can also becontrolled by a part of the slider and/or of the insertion tube, such asan extension of either or both of them. The locking means is anyarrangement which, induced by the movement of the slider, of the meansto move the slider or of the insertion tube, can immobilize the removalstring(s) to held IUS in stable position and again unlock the string(s)after insertion to release the IUS. Particularly, the invention relatesto a locking means which comprises an object capable of reversiblypreventing the movement of the string(s) by at least partly moving orpivoting from the original position, for example rotating around a shaftor an axle, and vertically or horizontally attached to the handle. Theobject may have several shapes and may be for example round orrod-shaped, wedge, polygonal or rectangular with rounded or sharpcorners. The surface of the object preferably comprises one or moreextensions having variable size and shape, for example a knob, a rib ora switch.

When the slider mechanism is pressed down and moved to adjust thecorrect insertion depth a part or an extension of the slider is pressedagainst at least one extension of the object thus changing itsorientation enough relative to the original position to cause release ofthe string(s). As soon as the slider is released, the strings will lockagain.

Preferably the object has a slot or pinhole through which the string(s)run. The locking means may also comprise at least one counterpartagainst which the string(s) are pressed by the object and thusreversibly immobilized in the locking position. The counterpart has asuitable shape adapted to fit at least some part of the surface of theobject. An extension, or extensions of the object can be used to keepthe object and the counterpart in a fixed configuration until the IUS isreleased. The counterpart preferably has a suitable design to keep thestring(s) in proper direction, for example a slot or pinhole throughwhich the string(s) run. Further, the object and said at least onecounterpart have preferably a suitable length and diameter to fit insidethe handle.

As an alternative or in addition to the locking means, the outer surfaceof the insertion tube or the handle can have means to hold the stringsuntil the intrauterine system has been inserted.

According to one embodiment of the invention, the locking means thuscomprises

-   -   a main part,    -   a first extension of the main part having an abutment surface,    -   a counterpart adapted to form a blocking together with the main        part,        wherein the locking means is rotatably mounted on the inserter.

According to another embodiment of the invention the main part comprisesan opening or a slot in a diagonal direction through essentially thewhole diameter of the main part, adapted to receive at least one removalstring of the intrauterine system.

According to yet another embodiment of the invention, the locking meanscomprises

-   -   a main part,    -   a first extension of the main part having an abutment surface,    -   a second extension of the main part having a wedge-like shape,    -   a counterpart adapted to form a blocking together with the main        part,        wherein the second extension is adapted to form a blocking        together with the counterpart and the locking means is rotatably        mounted on the handle of the inserter.

According to one embodiment of the invention, the main part hasessentially the shape of a cylinder, or it is of triangular shape, or ofany other suitable shape.

According to one embodiment of the invention the insertion tubecomprises an extension adapted to abut on the abutment surface of thefirst extension of the main part of the locking means.

According to one other embodiment of the invention the locking meanscomprises a main part comprising a first extension and a secondextension arranged, in their initial position, to be essentially incontact with each other to from a blocking, wherein a part of theslider, the insertion tube or a part of the insertion tube is arrangedto protrude into the main part of the locking means so as to separatethe first and second extensions from each other.

According to yet one other embodiment of the invention the locking meanscomprises

-   -   a first locking part and a second locking part movably mounted        on the inserter and arranged, in their initial position, to be        essentially in contact with each other to form a blocking, and    -   a first protrusion and a second protrusion arranged on the inner        surface of the outer insertion tube,        wherein the first and second protrusions are arranged to move        the first and second locking parts when moving the outer        insertion tube.

The locking means could also be welding, gluing, cutting, knot oradhesion. The strings could thus be for example attached to the body ofthe inserter by welding (for example by heating), gluing with glue orattaching with an adhesive agent (such as sticker). The insertion tubewould then release the attachment when contacting the slider. Otheroptions could be a knot or other mechanical hindrance, when the slotprovided for the strings is larger in the releasing position. Theinsertion tube could also comprise a blade that cuts the strings awayfrom the inserter.

It is obvious to a person skilled in the art that, in accordance withthe above description, the locking means can be of any other kind thanthose specifically listed above as well as a combination thereof.

During the preparatory steps the string(s) are hold tightly or lockedbut they are released automatically, when the slider is moved forexample to adjust the insertion depth or when the second end of theinsertion tube meets the slider or when the inserter is drawn out afterinsertion in order to release the IUS. As compared to previous insertersthere is no need to manually handle the removal strings during thepreparatory steps and during insertion, which increases security andhygiene and eliminates the possibility of user-made mistakes. Moreover,during the insertion the plunger and the medical device are protected bythe insertion tube up to the cervix, which also increases hygiene. Theinvention further relates to a kit comprising an intrauterine system andan inserter according to the present invention. The intrauterine systemcan be any intrauterine system known in the art. Any details andembodiments listed above naturally apply mutatis mutandis to the kitaccording to the invention.

The present invention also relates to a method for positioning anintrauterine system in a uterus of a patient, wherein the method uses aninserter according to the present invention. The method comprises thesteps of

-   -   sounding the depth of the uterus to obtain the correct        positioning depth,    -   moving the slider mechanism towards the second end of the        opening until its position corresponds to said positioning        depth, as shown by the depth markings of the handle,    -   introducing the inserter into the uterus of the patient until        the flange on the insertion tube abuts the cervical opening,    -   introducing the plunger with the intrauterine system further        into the uterus until the insertion tube meets the slider while        moving backwards away from the uterus, which shows that the        intrauterine system is in its correct location,    -   removing the inserter from the uterus of the patient.

An example of the method for positioning the intrauterine system isgiven hereafter. To insert the IUS only few steps are needed. To preparefor the insertion the sterile package is carefully opened. The IUS is ina correct configuration relative to the inserter and there is no need toalign the intrauterine system or for example to rearrange or correct theframe. The IUS is positioned at the forward end of the plunger with thereservoir of the intrauterine system protected by the extension of theplunger and the frame locating outside the plunger in the expandedconfiguration, secured and protected by the flange. The removalstring(s) attached to the intrauterine system are preferably immobilizedby the locking means, by the means on the surface of the insertion tube,or by both, to keep the IUS at a steady and correct position until it isreleased in the uterus. The removal strings do however not necessarilyneed to be immobilized.

Prior to the insertion procedure the depth of the uterus is measured bysounding. The slider mechanism or the means to move the slider is movedto correspond to the correct sounding depth. In the simplest form theslider is equipped with a self-locking press down and slide back buttonto adjust the correct sounding depth.

Then, the handle is hold tightly and the inserter is introduced into theuterus until the flange touches the cervical opening. At this point theinsertion tube starts moving backwards and the flexible plunger with theintrauterine system will go forwards into the uterus. The insertion iscontinued until the insertion tube meets the slider, when also theremoval string(s), if locked, are released by the locking means or bythe means on the insertion tube. At this point IUS is in the correctlocation, as determined beforehand by using a sound as described above.

The inserter thus allows easy and secure positioning of an IUS. The useof the slider mechanism is straightforward and the locking means to holdthe string(s) and the IUS immobile long enough as well as thepredetermined distances the insertion tubes can be moved in each stepguarantee an accurate positioning of the IUS during insertion and itsaccurate release.

DETAILED DESCRIPTION OF THE DRAWING

In the following description, the term slider and the correspondingreference number are used to designate both the slider itself and themeans to move the slider attached to the slider. The term slider is usedfor convenience of reading.

FIG. 1 illustrates a general overview of an inserter according to theinvention. The inserter comprises a handle 3, a plunger 2 attached tothe handle, a slider having means to move the slider 5, an insertiontube 6 around the plunger, an IUS and the string or strings (not shownhere) for the removal of the IUS, means for reversibly locking thestring(s) (not shown) in such a way that the IUS remains immobile inrelation to the plunger during the necessary steps prior to and duringinsertion, and again for releasing the string(s) and the IUS after ithas been inserted, an opening 8, a channel 9 in which the insertion tubeslides in the longitudinal direction, and depth markings 19 on thehandle which are used to adjust the slider to correspond the depth ofthe uterus.

In this case the forward part of the handle 3 forms an opening 8, havingthe first end 8 a and the second end 8 b, which opening runs in thedirection of the plunger 2 and has at the first end a channel 9 in whichthe insertion tube 6 slides in the longitudinal direction. The frontsurface of the means to move the slider 5 a is set on the depth markingcorresponding the depth od the uterus, i.e. the insertion depth, asdetermined before hand by using a sound or a probe.

FIGS. 2A, 2B, 2C and 2D illustrate an operating principle of theinserter.

FIG. 2A shows an inserter and in this case an almond-shaped IUS 1 in aconfiguration as they are in the sterilized package. The IUS is placedin the front end (entry into the uterus) of the inserter so that theelongate member of the intrauterine system or the elongated member witha drug containing reservoir is inside the head of the plunger and theframe of the intrauterine system is in the expanded configuration andpartly covered by the flange 4. The means to move the slider 5 is on thebasic position. The removal string(s) are inside the inserter, tightenedand locked by the locking means (not shown in the Figure) or outsideunder the insertion tube hold by suitable means or extensions.

FIG. 2B illustrates the first step of insertion procedure. After theinsertion depth has been determined by sounding, the slider is movedbackwards until surface 5 a is on a correct depth marking of the handle3.

FIG. 2C illustrates the procedure to insert the IUS. The intrauterinesystem in the configuration according to FIG. 2B is gently introducedinto the uterus until the flange abuts the cervical opening. The frameof the IUS will compress against the head of the plunger.

FIG. 2D illustrates the final step of insertion procedure. Insertion iscontinued from the step of FIG. 2C. The flange pressed against thecervical opening will cause the insertion tube to move backwards, andonly the plunger with the intrauterine system will move towards theuterus. The insertion tube will move until the rear end of the tubemeets the slider and at this point the intrauterine system is correctlypositioned in the uterus. The inserter is retracted out of the uterus.The strings and the intrauterine system are automatically released whenthe insertion tube meets the slider or when the inserter is drawn out.The distance the insertion tube can move has been selected to indicateclearly the moment at which the IUS has completely been positioned.

FIGS. 3A and 3B illustrate a locking means according to an embodiment ofthe invention. The locking means are arranged preferably at the insideof the handle 3, on any of the inside surfaces of the handle. Thelocking means are used to immobilise and release the string(s) of theIUS.

FIG. 3A illustrates a locking means according to an embodiment of theinvention comprising a main part 10 having essentially the shape of acylinder and comprising an opening 12 there through in a diagonaldirection. The string(s) 7 of the IUS pass through the opening 12. Themain part 10 is rotatably mounted on the handle, on a shaft or an axle(not shown). The locking means also comprises a counterpart 11, suchthat in the locking position the string(s) are immobilized between thecounterpart and the main part. The counterpart thus has a suitable shapeadapted to fit to a part of the surface of the main part. When theslider is moving backwards, at a suitable point a part or an extensionof the slider is pressed against the extension 10 a of the main part 10thus turning it enough to release the string(s), as shown in FIG. 3B.

FIGS. 4A and 4B illustrate a locking means according to anotherembodiment of the invention. FIG. 4A illustrates an object similar tothe one presented in FIG. 3A, but having a different construction of theextension 10 a.

FIGS. 5A and 5B illustrate a locking means according to yet anotherembodiment of the invention. This is a side view of a cylindricallyshaped locking means, having a main part 13 which comprises twoextensions 13 a and 13 b. The locking means can rotate around a shaft oran axle 14 and is preferably attached to a shorter side of the innersurface of the handle. The locking means also comprises a counterpart 15such that the string(s) 7 are immobilised between the counterpart 15 andthe extension 13 b. The counterpart 15 has a suitable shape adapted tofit to a part of the surface of the extension 13 b. When the slider ismoving backwards, at a suitable point a part or an extension of theslider is pressed against the extension 13 a thus turning it enough torelease the string(s), as shown in FIG. 5B. In this case the handle canalso comprise a groove in which the string(s) run (not shown).

FIGS. 6A and 6B illustrate a locking means according to an embodiment ofthe invention. The locking means 16 comprises two extensions 16 a and 16b to immobilize the strings as shown in FIG. 6A. When the slider 5 andthe insertion tube 6 move backwards the slider and/or the insertion tubeprotrudes into the locking means at least partly to expand the meansenough to separate the extensions and to release the strings, as shownin FIG. 6B.

FIGS. 7A and 7B illustrate a locking means according to a furtherembodiment of the invention. The locking means comprises two parts 17 aand 17 b to immobilize the strings as shown in FIG. 7A, said parts beingable to move or turn from the original position. The slider 5 has twoextensions 18 a and 18 b. When the slider 5 and the insertion tube 6move backwards the slider extensions turn the locking parts 17 a and 17b apart from each other enough to release the strings, as shown in FIG.7B.

FIGS. 8A and 8B illustrate an intrauterine system and its positioning onthe inserter according to an embodiment of the invention. Theintrauterine system has a frame 1 a and a therapeutic component 1 b andit is positioned in the plunger or in an extension of the plunger 2. Theintrauterine system is connected to the inserter via one connection part19. The first end of the plunger 2 comprises one connection slot 20 forreceiving the connection part 19. The therapeutic component isessentially completely and the frame essentially only partly positionedin a frame slot 21.

FIGS. 8C and 8D illustrate another intrauterine system and itspositioning on the inserter according to an embodiment of the invention,which has the same parts 1 a, 1 b, 2, 19 and 20 as in FIGS. 8A and 8B.In this embodiment, the therapeutic component is essentially completelypositioned inside the plunger and the frame is essentially completelyoutside the plunger.

FIGS. 9A and 9B illustrate some details of FIG. 8B, namely the first endof the plunger 2 and the connection of the intrauterine system on theplunger.

The invention claimed is:
 1. An inserter for an intrauterine system, theinserter comprising: a handle with a first end and a second end, thehandle having a longitudinal opening at the first end, the longitudinalopening having a longitudinal axis parallel to the longitudinal axis ofthe inserter; a slider, with a first end and a second end, the sliderarranged in the longitudinal opening; a plunger attached to the handleand having a longitudinal axis; an insertion tube with a first end and asecond end, having a longitudinal axis essentially parallel to thelongitudinal axis of the plunger, the insertion tube being movablyarranged around the plunger; and a lock for immobilizing a removalstring, wherein the lock is controllable by the slider.
 2. The inserterof claim 1, wherein the slider comprises two elements that are combinedby a transversal member by which the slider can be moved.
 3. Theinserter of claim 1, wherein the handle comprises a support, a shoulder,a holder, a saddle, a groove, or a slot that facilitates movement of theslider.
 4. The inserter of claim 1, wherein the intrauterine systemcomprises a therapeutic component.
 5. The inserter of claim 4, whereinthe therapeutic component comprises levonorgestrel.
 6. The inserter ofclaim 1, wherein the lock comprises an object that forms a slot orpinhole through which the removal string runs.
 7. The inserter of claim6, wherein the lock further comprises a counterpart against which theremoval string is pressed by the object to reversibly immobilize theremoval string in a locking position.
 8. The inserter of claim 1,wherein the lock reversibly prevents movement of the removal string byrotating around a shaft or an axle.
 9. The inserter of claim 1, furthercomprising: a flange arranged on the insertion tube at its first end,wherein the flange is arranged to be in contact with the intrauterinesystem and surround the intrauterine system before insertion.
 10. A kitcomprising an intrauterine system and the inserter of claim 1.